Analyzing Rick Perry’s record: Health care falters in state

This is the second of four stories looking at the state of Texas infrastructure under the tenure of Rick Perry, the longest-serving governor in state history. This report was written by Patricia Kilday Hart and Gary Scharrer of the Austin bureau.

Seven years ago, when Jake Margo graduated from Texas A&M University medical school, he chose Rio Grande City, one of the poorest towns in Texas, to begin his career. There, he plunged into grueling 80- to 90-hour workweeks seeing a blur of patients with every medical issue imaginable, often feeling guilty about leaving his clinic.

Why choose a community that promised such hard work? It’s Margo’s hometown, and the state of Texas offered a tantalizing loan repayment for physicians willing to practice in remote areas in desperate need of doctors.

“You are filling a huge need in one of the most remote communities in the state,” Margo said.

This year, however, state lawmakers facing a $15 billion budget shortfall slashed funding to the loan-repayment program that encourages doctors like Margo to set up shop in underserved areas.

As Gov. Rick Perry travels the country in his bid for the Republican nomination for president, his and Texas’ record on health care issues — particularly in light of his criticism of the health care reform bill touted by President Barack Obama — will draw fresh scrutiny.

With 26 percent of its citizens lacking health insurance, Texas ranks the worst in the nation for health care coverage. Premiums are well above the national average. The number of Texans who qualify for Medicaid has grown 80 percent since 2001.

While Perry trumpets the state’s balanced budget, he fails to mention that lawmakers this year cut $805 million from doctors serving Medicaid patients, and that they also postponed $4 billion in Medicaid costs for payment in the next budget cycle.

The state’s population growth of 4 million new residents over the last decade, coupled with budget cuts to medical education and Medicaid providers, has put Texas health care access on a dangerous trajectory.

Ranks 48th out of 50

Perry touts his lawsuit reform policies, which helped lure 17,000 new physicians to the state, but that hardly made a dent in Texas’ growing needs for health care professionals.

More than 5.2 million Texans live in areas designated as official health professional shortage areas.

Texas ranks 48th out of 50 states in the number of physicians per 100,000 residents. In addition to cutting the loan repayment program, lawmakers this year reduced state support to graduate medical education by almost 40 percent, ensuring that many medical school graduates will leave Texas to other states for residency programs. Since statistics show that doctors usually begin their careers where they train, that means Texas taxpayers have footed the bill to educate doctors who move to others states.

Lawmakers also slashed 80 percent of the state’s investment in the production of primary care doctors by reducing funding to a loan repayment program – like the one Margo took advantage of – and a primary care mentoring program. Texas Academy of Family Physicians CEO Tom Banning said the impact of the cuts means “we will have fewer physicians caring for Texas patients at time we need to be growing that base.”

Other budget cuts – particularly an 8 percent cut in reimbursement rates to hospitals – could undo the settlement of a federal lawsuit by constricting the availability of health care available to Medicaid recipients, experts say. The state had agreed to improve its payments to hospitals and doctors to ensure that Medicaid patients have somewhere to go when they get sick.

John Hawkins, senior vice president of the Texas Hospital Association, noted that the 8 percent cut to hospitals came on top of a 2 percent cut in the last budget, in addition to a 23 percent cut to trauma care funding. In all, he said, the new state budget will “increase costs to those with health insurance, require higher local taxes and reduce access to health care services in communities statewide.”

Most of Texas’ new jobs are low income and have been accompanied by a soaring number of Texans who qualify for Medicaid – from 2.1 million in 2001 to 3.5 million today.

“We can be sure that everyone who is moving here either does not necessarily have a job or they are possibly forced to take a job where they are under-employed,” said Hawkins. “They likely cannot afford health insurance so they put more pressure on state services that are currently underfunded.”

His view was confirmed by Harris County Hospital District’s Dr. Bob Trenschel, who has seen an exponential growth in demand for services.

“I liken it to pouring 20 ounces of water in a 16-oz glass. It can’t fit. And the demand for services continues to be extraordinarily high,” Trenschel said. “You almost can’t build capacity in the system fast enough.”

Governor’s response

Perry spokeswoman Lucy Nashed said Perry believes he could improve Texas health care access if the federal government gave states a block grant for the Medicaid program.

She also pointed that the legislature passed, and Perry signed, legislation that “enacts cost savings and quality improvement measures in the Medicaid programs” by giving incentives to reduce emergency room use and expanding managed care.